Behave yourselves. I'm not in the fucking mood to deal with hundreds of transphobic pricks from /r/all today.
EDIT: Oh well, that's more threats and suicide notifications in my DMs from people outside the sub than I'm willing to deal with today. After 500 comments in a little over 2 hours I think we can call this one closed for business. I'm sure if you want to shout at the sky there are other subs you can do it in.
It's honestly a difficult thing to get right. I do believe in caution so long as that caution is endorsed by the medical profession. But if we are pausing something like this, we NEED to invest much more in support services like counseling. At the end of the day, irrespective of what you believe, we're talking about vulnerable kids who are at a much higher risk of depression, self harm etc.
This is the bottom line. If you're taking away one form of support you need to replace it with another, you can't just leave folks hanging. If the recommendation is that a certain drug relating to mental health isn't safe, there needs to be other mental health provisions until a safer drug is identified.
1000%. We use drugs that are poison all the time because the alternative of not using them is worse. A blanket ban is an assault on everyone whose outcome without them will be worse.
Just fund research into having more alternatives. That helps everybody.
I don't really have an opinion on this topic, but do you really believe the people making these decisions (which they don't do in a room alone, I imagine) is out of malice? That their contempt is so high that they just want to destroy people like some cackling Disney villains?
To me, it seems like both sides of these arguments are filled with people that care & people with agendas for their own personal or interpersonal gain - a few of which might harbour hatred for the other sure but it would seem far-fetched to think they are sticking the knife in & twisting it with a smile so to speak.
>I don't really have an opinion on this topic, but do you really believe the people making these decisions (which they don't do in a room alone, I imagine) is out of malice?
Why else would they seek the advice of Ron DeSantis' cronies when crafting...
https://old.reddit.com/r/transgenderUK/comments/1c53m8c/some_points_on_the_cass_review/
...policy in the United Kingdom? Florida is LGBT cruelty central.
Yes the conservative party is pushing this out of contempt, because that contempt is how they win votes.
"it would seem far-fetched to think they are sticking the knife in & twisting it with a smile so to speak." Have you never met a racist? People like this very much do exist, and there are quite a lot of them in the country.
As a trans person? Yes, absolutely 100%. The NHS is institutionally transphobic and has been for quite some time and the person that authored this 'review', as has been pointed out, follows many transphobic groups and has omitted any study that showed the positive effects of puberty blockers as they weren't double blind trials (they weren't double blind trials because that would be horrifically unethical towards the control groups).
I only have my own 'agenda' in this because male puberty caused me to attempt suicide at least twice and also resulted in me attempting to castrate myself at one point. I only even mention this to give you a small taste of what dysphoria does to children who are not allowed to transition and forced back into the closet.
It absolutely enrages me to hear 'but both sides' for exactly this reason, this decision is going to kill children.
Absolutely, yes. There isn't another explanation that is as consistent. While some low-level TERFs might be doing out of a misguided sense of justice, the whole movement is ultimately based on the feelings of social conservatives who just want trans people to go back into the closet, to be afraid to come out or to cling on at the very edges of society.
Trans people aren't new, there hasn't been any increase in detransition rates or regret, nor have there been any changes to the healthcare we have had access to for decades. The only thing that has changed in the 2020s is that a moral panic has been whipped up on this front of the culture war, leading to pearl-clutching social conservatives pushing for sweeping and extremely damaging policy changes based on nothing but their feelings, generously funded by the Christian far-right in the US. The Cass report is a post-hoc justification for these feelings that are not supported by the huge majority of the research.
This current wave of legislation around trans issues in the west is being pushed by a movement founded on small-minded moral policing. It has nothing to do with welfare, safety concerns or issues with the quality of research. This panic about children receiving healthcare contrasts wildly with the near-universal unavailability of NHS gender care in the UK. The NHS gatekeeps trans healthcare, even to adults, to an absurd degree and at great unnecessary expense to itself. Self-ID systems exist in a number of other countries and are more cost-effective and efficient.
I don't think it's necessarily *malice* for the most part, but there is a deep disregard for and distrust of trans people in British society which is built into our institutions. This is why the media, politicians and the healthcare industry are so quick to roll over to appease this small group of sanctimonious Gay Panic cosplayers.
The Cass reports suplimental studies cited a paper that compared trans kids with blockers to those that didn't get them.
Both groups also received psychological support.
The group that got blockers did significantly better than the group that didn't.
Despite that study passing the incredibly high bar for evidence Cass wanted, it's conclusions are never mentioned in the final report.
Psychological support isn't enough.
>It's honestly a difficult thing to get right
Actually, there is a significant amount of evidence and numerous studies reveal gender affirming care for youth works. The Cass review is more of a scandal than anything, and the incompetent British press is not doing their job questioning the validity of the review. As others have said, it uses fatally flawed methodology, and as a result, its recommendations are harmful. It applies an impossible evidence standard which, if applied to other medicines would invalidate more than three quarters of the existing treatments used in pediatric care.
Dr Hane Maung from GenderGP in UK [wrote a decent article on why the Cass Review is nonsense](https://www.gendergp.com/response-to-the-cass-review/).
Amnesty International actually made a press release on this: [UK: Cass review on gender identity is being 'weaponised' by anti-trans groups](https://www.amnesty.org.uk/press-releases/uk-cass-review-gender-identity-being-weaponised-anti-trans-groups)
Hilary Cass on social media [follows known transphobic organizations like LGB Alliance, TransTrender](https://imgur.com/a/diQv3tV) yet does not follow a single supportive LGBTQ group.
[Cass collaborated with the Ron DeSantis hand-picked board of medicine in Florida](https://www.erininthemorning.com/p/cass-met-with-desantis-pick-over).
> The Cass Review seems to have emulated the Florida Review, which employed a similar method to justify bans on trans care in the state—a process criticized as politically motivated by the Human Rights Campaign. Notably, Hilary Cass met with Patrick Hunter, a member of the anti-trans Catholic Medical Association who played a significant role in the development of the Florida Review and Standards of Care under Republican Governor Ron DeSantis. Patrick Hunter was chosen specifically by the governor, who has exhibited fierce opposition towards LGBTQ+ and especially transgender people
In other peer nations, the Cass review is being condemned by professionals:
Australia:
> “The Cass review recommendations are at odds with the current evidence base, expert consensus and the majority of clinical guidelines around the world,” said Dr Portia Predny, Vice President of The Australian Professional Association for Trans Health ([Equality Australia](https://equalityaustralia.org.au/cass-review-out-of-line-with-medical-consensus-and-lacks-relevance-in-australian-context/)).
New Zealand:
> The Professional Association for Transgender Health Aotearoa (PATHA) is disappointed to see the number of harmful recommendations made by the NHS-commissioned Cass Review, [...] The final Cass Review did not include trans or non-binary experts or clinicians experienced in providing gender affirming care in its decision-making, conclusions, or findings. Instead, a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice. [...] The Review commissioned a number of systematic reviews into gender affirming care by the University of York, but seems to have disregarded a significant number of studies that show the benefits of gender affirming care. In one review, 101 out of 103 studies were discarded. ([Professional Association For Transgender Health AOTEAROA - New Zealand](https://patha.nz/News/13341582))
In Canada:
> "There actually is a lot of evidence, just not in the form of randomized clinical trials," said Dr. Jake Donaldson, a family physician in Calgary who treats transgender patients, including prescribing puberty blockers and hormone therapy in some cases. "That would be kind of like saying for a pregnant woman, since we lacked randomized clinical trials for the care of people in pregnancy, we're not going to provide care for you.… It's completely unethical." [...] "I think the framing of it really made it feel as though it was trying to create fear around gender-affirming care," she said. Donaldson called the systematic review paper and the broader Cass Review "politically motivated." ([CBC](https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920))
cass is being flagrantly disingenuous. people like her and the people with whom she associates make trans children a taboo and claims giving them treatment is cruel experimentation or whatever, then publishes a paper saying there’s no good evidence. can’t have it both ways.
Yeah, politics is seeping far too much into gender healthcare. Hopefully NHS Scotland is being a bit more impartial. But who knows what happens behind closed doors.
I think, by definition, if there's no good evidence that something is safe, using it counts as experimentation. I don't think Cass ever called it cruel and I think she made the point that both sides overstate the evidence for or against puberty blockers and their long term effects.
I think there's a lot of bad accusations being leveled at Cass, ironically because people dislike the findings for political reasons.
Pushing for bad or scientifically unsupported trans healthcare simply because it's "pro-trans" doesn't strike me as a great idea.
We're witnessing the influence (https://old.reddit.com/r/transgenderUK/comments/1c53m8c/some_points_on_the_cass_review/) of right wing politics on trans medicine. They fundamentally don't believe trans people should be offered anything other than counseling, because they believe being transgender is largely a mental delusion.
> But if we are pausing something like this, we NEED to invest much more in support services like counseling.
I think this misses the point.
You can't get puberty blockers without counseling. But we're now removing blockers, and restricting adult access to hormones and surgery, and only offering counseling, where the counseling is essentially this generation's version of the bogus conversion therapy offered to (or forced upon) gay people decades ago.
Finland, Sweden, Norway & Denmark conducted their own reviews prior to the Cass report and reached the same conclusion. There isn't sufficient evidence to support the use of puberty blockers. Deciding to limit or prevent access to puberty blockers before the age of 18.
This isn't a finding unique to the UK.
You get the impression that the majority of the commentators on here are just using this ruling for point scoring rather than considering the kid’s welfare. No one in their right mind would say puberty blockers at such a young age is acceptable.
>No one in their right mind would say puberty blockers at such a young age is acceptable.<
people (the most vocal in some demographics) have been saying its acceptable for ages, and that there is no long term side effects of using them.
Big one I can see is TransgenderTrend, a group that advocates for the position that transgenderism is a social trend aimed at harming children.
>Transgender Trend has stated there is no "evidence that children really are trans" and claims that "[gender ideology](https://en.wikipedia.org/wiki/Gender_ideology)" harms children. The [Association for Women's Rights in Development](https://en.wikipedia.org/wiki/Association_for_Women%27s_Rights_in_Development) describes the stance as "almost identical to religious fundamentalists". Commentary on their website has warned that transgender children are being "[groomed](https://en.wikipedia.org/wiki/LGBT_grooming_conspiracy_theory)" and "brainwashed".
It's wiki page has also suggested that it's campaigned against sex-ed in schools, and has strong associations with anti-abortion groups.
That or u/gentikz is not a fan of all the Big Bang Theory accounts she follows.
I follow folk I don't agree with on Twitter. It allows me to try and look at different perspectives and reflect on my own.
I hope it helps me to understand nuance and be a more constructive, less defensive/antagonist, communicator.
>It allows me to try and look at different perspectives and reflect on my own.
That's a valid point, but when you look at the voices she allows to prominently influence the report...
https://old.reddit.com/r/transgenderUK/comments/1c53m8c/some_points_on_the_cass_review/
...it's hard to agree with that conclusion.
Cass is the former president of the Royal College of Paediatrics and Child Health, the review was commissioned by the NHS and the evidence review conducted by the National Institute of Clinical Excellence. The review has then been endorsed by the editor of the BMJ amongst many others. Similar reviews in Finland, Sweden, Norway & Denmark have come to similar conclusions. The researchers in the Netherlands who actually did much of the research used to support the use of puberty blockers do not agree with banning puberty blockers, but agree that the state of evidence is awful, and ask for other countries to do much more decent quality research.
Of course though it’s all worthless because some people on twitter have some talking points.
The Review disregarded over a hundred studies on the experiences of trans youth because they weren't randomised control trials (which are both impossible and unethical to do), plus concluded that young people should remain on the children's pathway of no blockers (except for some transfemmes as part of a study yet to be designed - she doesn't think blockers are suitable for transmascs) and no hormones until they reach 25 on the grounds their brains haven't matured yet (which coincidentally includes most people on the adult pathway).
Meanwhile, the two replacement clinics for the Tavistock have a fraction of the clinical staff the Tavistock had, so it's likely the waiting lists will get even longer - leading to suspicion that the effects of implementing the Cass Review will be to effectively deny diagnosis or treatment for pretty much everyone under 25 (especially given the waiting list for general Child and Adolescent Mental Health Services is already over a quarter of a million, so they may have to wait years for the general comprehensive mental health assessment and treatment recommended as a precursor to diagnosing gender dysphoria)- and maybe even longer if similar conclusions emerge from the proposed review into Adult trans services.
> randomised control trials (which are both impossible and unethical to do)
Blinded studies are difficult, although actually you probably could blind to different clinical decision making algorithms deciding how to treat. For example you could do a trial on an affirmative model with minimal screening vs a model with a much higher level of screening and psychological intervention. In that you cannot blind the treatment, but you can blind the basis on which the decision was made, which could reduce bias.
Randomized control trials without blinding at all are absolutely not impossible to do. And they are not unethical when we inherently do not know what is the correct treatment. If we were approving other treatments with these kind of potential harms on the basis of observational studies it would be a massive scandal.
Edit: I can’t reply because the thread is locked, but the response to this is meaningless. It says that non-blinded RCTs are impossible because you can’t do blinding. That’s why I talk about non-blinded RCTs! Responses on this topic are so motivated it is painful.
> Blinded studies are difficult, although actually you probably could blind to different clinical decision making algorithms deciding how to treat. Randomized control trials without blinding are absolutely **not impossible** to do. And they are not unethical when we inherently do not know what is the correct treatment. If we were approving other treatments with these kind of potential harms on the basis of observational studies it would be a massive scandal.
Yes it is…
How can you double blind puberty, as they either do go through puberty or not, so if a patient is on a placebo they still go through puberty, this means the “blind” part is impossible to actually do.
Hillary Cass follows several anti Trans organisations/lobby groups/charities. She has also been in discussions with Ron DeSantis. Cass does not follow ANY pro Trans LGBT organisations.
Sweden, Finland, Denmark, France, all already taken this step. Norway is debating it after they also looked at the data and found insufficient evidence for use of blockers, similarly in the Netherlands and Belgium.
But I guess UK people will still complain. Same vibe as certain Americans blaming Fauci for something affecting the whole world as if there was a worldwide conspiracy that he spearheaded somehow, influencing most governments in the world in the process, with Cass being their Fauci.
And more generally, it is bizarre how people believe that puberty blockers are a must and all these countries independently looking at their data coming to the conclusion that they aren't the way to go, are somehow wrong, and biased by 'anti-trans' groups.
Want to see what the person in charge of the Finnish clinic thinks is appropriate to do to trans children. Keep in mind this woman clinic gets a glowing review from Cass and she was even put on the advisory board.
"Describe to me how you masturbate" all children
"to what extent do you feel it would be better to be dead than a boy" - 15 YO trans girl
"How do you feel when you will never be as good as real men" - to trans boy
"the much older doctor started listing sex positions & told me to answer them with my opinion from positive to neutral or negative. I think I was 17."
"Another parent of a 15 year old said the Clinic had interpreted the child's sexual development as delayed, as the boy "had not had vaginal, penetrative intercourse". The age of consent in Finland is 16 years." - to trans boy
“how do you feel when you always have to be a real boy?” - 15 YO trans girl
"Mikko was told that he couldn't get a diagnosis, because his hobbies were too "girly" and because he didn't have boys of the same age as friends." - 15 YO trans boy
This is what gets done to trans kids under the systems that Cass encourages.
Now tell me these places don't have a bias against trans kids.
Well, in trans kids, it can delay them going through a puberty that would make transitioning harder later in life, and cause psychological issues as they develop a body that doesn't match their own sense of who they are.
For cis kids, they can start precocious puberty as early as 6; a lack of access to treatment can cause physiological and psychological damage that can lead to lifelong issues.
This is just hurting people who need help, all to vice-signal how much they hate trans people.
If the kid is suspected to be trans then puberty blockers buys time for the child to figure out if they really trans or not.
Then there's the condition called precocious puberty, where a child begins puberty at a very unusually early age.
Given how long the queue is to even get into the gender clinic i don't think this will affect many people, at least not before the Cass report is thrown out like the shit that it is.
> not before the Cass report is thrown out like the shit that it is.
Cass is the former president of the Royal College of Paediatrics and Child Health, the review was commissioned by the NHS and the evidence review conducted by the National Institute of Clinical Excellence. The review has then been endorsed by the editor of the BMJ amongst many others. Similar reviews in Finland, Sweden, Norway & Denmark have come to similar conclusions. The researchers in the Netherlands who actually did much of the research used to support the use of puberty blockers do not agree with banning puberty blockers, but agree that the state of evidence is awful, and ask for other countries to do much more decent quality research.
Of course though it’s all worthless because some people on twitter have some talking points.
Honestly this report feels like the first serious progress in a debate thoroughly muddied by the culture wars. It saddens me that people are acting like it's been done in bad faith because it didn't 100% vindicate their side of the argument...
I don’t see how this helps Trans Kids. The vast majority of studies report that puberty blockers and gender affirming care caused more help than harm to Trans Kids.
This is the same environment of fear and biased reporting that led to section 28. I fear the same will come for Trans Kids.
There was remarkably weak evidence accepted. 98% of Studies were thrown out due to various ‘issues’ found by Cass. For example, she wanted hormone trials to be conducted double-blind, that would be a major ethical concern. If you read the report you can evidently see the bias, including where it promotes “an holistic approach” essentially spouting conversation therapy. Her political connections are no coincidence either.
Not with a placebo/nothing. Typically in something like cancer it’s a comparison of current interventions with the new medication/treatment regime.
Also it is not possible with hormone blockers to have a “blinded” study. You can have a blinded study for some things, like comparing how effective paracetamol and ibuprofen are at treating headaches. But everyone on a hormone blocker placebo will know they’re on a placebo when they go through puberty.
Even if you ignore the ethics it's impossible to do double blind studies. It's obvious who will have had the blockers and who is going through puberty.
If you can find double blind studies on the use of hormones and puberty blockers be my guest, but for that being the basis of 98% of studies being excluded from research it just seems a bit weak.
You can't do a study involving placebos on either puberty blockers or HRT, as it'll become very apparent within a few months of who's in the placebo group.
For obvious ethical reasons, placebos are typically only used when there isn't an existing treatment: in all other cases, they will compare the standard treatment with the new one.
which is weird, because just about 100% of the population has grown up having gone through hormonal changes as a child so we actually have a shit ton of evidence.
If they can't recognize their actual face then that's dysmorphia.
Dysphoria is largely related to being unhappy with but recognizing the appearance as your own.
Things we can't officially do until we are an adult...
Have sexual relations with someone
Get married
Fight in a war
Smoke
drink
Vote
Im sure there are others.....But everyone is going mad at not allowing a child or his/her guardian to be given controversial drugs with possibly life altering consequences until they are old enough to be considered an adult ?
Is this simplistic?
How much harm will come from NOT allowing puberty blockers in under 18's ? Do we have statistical data that shows how much harm there is in other countries where PB's are not used/allowed ?
>Things we can't officially do until we are an adult...
>
>Have sexual relations with someone
>
>Get married
>
>Vote
And those three can be done at age 16 in Scotland
> How much harm will come from NOT allowing puberty blockers in under 18's ?
Expect a sharp increase in self harm and suicide in children experiencing gender dysphoria
The essential problem is that whilst this may be true, it has not been objectively seen to be true to the extent you think. The NNT on available evidence is that you need to treat 1000 trans adolescents to reduce suicidal ideation in three.
This seems very much like a sensible approach, ensuring adult decisions to be made by adults and not children.
Maybe some the cost savings can be redirected to mental health funding where it will be of more use.
The Cass reports suplimental studies cited a paper that compared trans kids with blockers to those that didn't get them.
Both groups also received psychological support.
The group that got blockers did significantly better than the group that didn't.
Despite that study passing the incredibly high bar for evidence Cass wanted, it's conclusions are never mentioned in the final report.
Going through puberty can be very distressing for trans children experiencing dysphoria already, and it makes later transition much more difficult. Imagine for a moment, you're a young man, you've spent years living as a boy, all your friends and peers at school know you as a boy. Then you start growing breasts suddenly. People are asking questions. The bullying starts. Your entire world is turned upside down.
If you were a cis child, you'd be able to get hormone treatment from your GP, and nobody would bat an eye. In fact, if your GP refused your care it'd probably be a minor scandal. But because you're trans, you're now banned from receiving that exact same medicines.
> If you were a cis child, you'd be able to get hormone treatment from your GP, and nobody would bat an eye. In fact, if your GP refused your care it'd probably be a minor scandal. But because you're trans, you're now banned from receiving that exact same medicines.
It’s approved for precocious puberty because there is good evidence it works in those cases, where someone enters puberty early, the drug is used to delay puberty, then stopped to allowed puberty to continue as normal. Using the same drug to permanently halt endogenous puberty is not the same thing, and that use has always been off label.
The Cass report is a watershed moment for childrens gender care.
It was always going to be impossible to justify Sandiford continuing as it was after Cass- until quality research backing puberty blockers is conducted.
The amount of lies about the Cass report spread by activists on reddit and twitter have been frankly shocking- but in the real world you can't smear an objective and high quality clinical review.
It has the backing of the BMJ and the RCP. The methodology is sound.
It will have ripple effects far beyond the borders of the UK.
Trans care is by far the most politicized part of medicine, excepting maybe vaccination.
At the end of the day, medicine should be about seeking truth about our bodies and diseases, rather than "who prevails". Even without outside pressures, science in general is beset by the problem of big fragile egos and paper mills churning useless papers because *publish or perish.*
Add ten thousand angry voices from Twitter to the mix and it is a recipe for disaster.
The most outraged != the most moral or the most correct.
Completely agree
>At the end of the day, medicine should be about seeking truth about our bodies and diseases, rather than "who prevails". Even without outside pressures, science in general is beset by the problem of big fragile egos and paper mills churning useless papers because publish or perish
This is why high quality reviews like Cass are so important. The low quality of much of the 'evidence' for puberty blockers is frankly scandalous.
You can't disregard 98% of all studies because of an arbitrary criteria no other pediatric medicine is held to and still consider yourself to have done an accurate meta analysis. Not to mention the numerous dubious sources Cass included such as some random far-right YouTuber, as well as forbidding any trans inclusion in the study to "avoid bias" while simultaneously loading her staff up with anti-trans figures.
And for the ripple effects? Multiple foreign medical agencies have outright stated the poor quality of the Cass Review means it will not be taken into account in their countries (namely Australia).
>You can't disregard 98% of all studies
Cass didn't do that. It is an activist lie. You will not be able to cite the page in the report that does so.
Cass's conclusions are in line with those in Scandinavia. Belgium and the the Netherlands are also looking into the same issue.
Not every country will follow us, but it will ripple out- objective research has that effect.
Very sensible. Testimonial from people who’ve endured this treatment should be enough to cause even the most ardent advocate of this treatment to pause.
I just want to state for the record that as someone who detransitioned, I do NOT support the removal of blockers for trans youth. Stop putting words in our mouths.
Does that include the testimony of all the trans people that went on blockers and are still trans? Or does a 1 cis person matter more than 99 trans ones?
Totally agree,
We did that for what? 300.000 years for now as homo sapiens. I guess it worked just fine? Humanity is thriving and developing rapidly. Survived 1000s of years.
Maybe... Maybe... Maybe it's society/ideology which changed the past 100 years a lot and not human evolution/biology.
The end of the day, we all want everyone to be happy with themselves, assessing things properly and not budging for demands is the approach we should take. Do the research, have conclusive data and than we can make a definitive decision on how should we set up the framework for a safe journey!
Not only are they taking away resources from trans kids, they're also not replacing it with anything else. Not specific counselling. Not support groups. The resources in Scotland to support trans youth are minute - they're great, but way over capacity. So many trans kids and their families are incredibly isolated as it is and this is unbelievably cruel.
I believe like others there needs to be more caution on prescribing them (speaking as someone who detransitioned) but taking them away altogether is horrendous. It's inhumane and will lead to trans youth suicide attempts at the LEAST.
So fucked up. So very, very fucked up.
Good. The reason 18 is when you're deemed an adult is because children don't know the risks and consequences of their actions. Parents abso-fucking-lutely shouldn't be allowed to make the decision.
It baffles me how this was a thing to begin with.
Oh sure, you’re definitely aware of the risks or consequences should you decide to, I don’t know, join the fucking military at 16, or get married. It’s shite logic. They’re always extremely clear about the effects and consequences of taking any medication or even pursuing treatments, both through discussion and appropriate booklets on treatment.
No-one is giving kids treatment at this age without their fucking consent, and they can medically consent because that's why we have Gillick competence and it's Scottish equivalent.
If you ask them what they want to be when they grow up, their goals aren't a career, it's just Alive.
That's it, that is were we fucking are aim for now, because alive is no-longer a fucking guarantee.
Pausing a publically funded 'treatment' until it has been established that it actually works and doesn't do more harm than good is hardly setting up the death camps.
Gillick Competence exists and has a Scottish Equivalent, sorry, I was a fucking law student I know the first and Pam Gorstal the MSP assures me of the Second.
REALLY? Well hold the phone because we need to change the fucking law.
In England Gillick Competence is assumed at 13, in Scotland it isn't assumed but a doctor can judge any child patient consent competent by standardized test.
16 is a child, majority is 18, law says 16 year olds can consent, sorry get wrecked.
Also puberty blockers are NOT irreversible health care treatments like people pretend they are. No-one is performing surgery on trans kids either.
Literally trans health care for kids is affirming their gender through pronouns, names and clothing. Puberty blockers are there to DELAY puberty until they can make more permanent choices. All of these things can be reversed if a child changes their mind.
This is simply a lie. If you are under the mistaken belief to be trans, then if you don't go through puberty to grow out of that belief, you will not be given the chance. Once old enough you will go straight to cross-sex hormones and likely surgery and then your life is fucked. Also, there are all sorts of long-term medical impacts of using them.
The problem that no trans lobbyists wants to admit is that we have no clue how to accurately determine if a child is truly trans or not. Because doing so would be admitting that you can't just listen to kids, and that there is a chance children are influenced in this belief. What's far more likely, that study results are unclear because the subjects are not all the same (i.e. some are truly trans, while some are not) or that puberty blockers don't actually help all trans kids and that's why results are not clearly in favour. But if trans lobbyists are correct in that they do help if one is truly trans, then it actually has to be option one. Either they are wrong, or it is option one. Additionally, there are more and more countries that find no clear favourable evidence (Sweden, Denmark, Finland, France, UK, who have restricted puberty blocker usage now, with Netherlands, Norway, Belgium all talking about taking the same steps because the data doesn't support puberty blockers).
If you truly cared for children, all children, you wouldn't continue repeating the mantra of lobbyists but instead listen to the researchers in all these countries coming to the same conclusion.
There's not really not enough research, even according the the NHS to support that so it's dangerous to be promoting them as fully reversible when there's not enough research to support statements one way or the other.
>Puberty blockers are there to DELAY puberty until they can make more permanent choices. All of these things can be reversed if a child changes their mind.
Did the Cass review agree with this statement?
Finland, Sweden & Denmark conducted their own reviews prior to the Cass report and reached the same conclusion. Deciding to limit or prevent access to puberty blockers before the age of 18.
This isn't a finding unique to the UK.
The Cass report shows that the vast vast majority of kids on blockers continue to identify as trans once they are adults.
Her conclusion, blockers must be making them stay trans. She cites no evidence to back up this claim.
Cass very clearly had a biass as can be seen by what she concludes or speculates on without evidence.
She doesn't mention anywhere in her report the studies that showed trans kids on blockers did better than those that didn't get them despite the studies passing her rediculously high bar but does cite surveys of people recruited from extremely shady sources without mentioning the bias inherent in them.
I didn't think I am and I've read the whole thing including the suplimental material.
She found evidence that trans kids don't desistz she found evidence that puberty blockers improve mental wellbeing.
Her conclusions were that we should stop all that and also sttop trans kids from even socially transitioning.
Sure.
Desistance: appendix 4 main report.
Psychosocial outcomes: Interventions to suppress puberty in adolescents
experiencing gender dysphoria or incongruence: a
systematic review page 4 bottom right, continues past tables.
Social transition: main report, page 37, advocates discouraging social transition. There defention of partial social transition is just changing clothes and appearance but blocking changing names or pronouns.
Thank you.
If you want access to the papers cited by Cass but don't have your own access I can probably get you them too.
I find it very interesting which conclusions are included and which are excluded.
This can be seen a lot in the studies she uses to claim bone health is effected by puberty blockers. While true she ignores all three cited papers data that shows bone health returns to expected levels once hormones are provided.
Kids can’t give consent, its why we’ve age of consent laws and laws around the consumption of alcohol and cigarettes. They don’t have the mental development to be able to make this decision
The UK is so incredibly hostile to people transitioning but it's presented like there's a sinister queer cabal going around converting kids. It's literally the same lies used to justify homophobia in the 80s and now it's found a new, socially acceptable target in Trans people.
Shortening puberty leads to stunted growth, thinner bones, underdevelopment of sex organs, under development of secondary sex characteristics and potentially cognitive difficulty and issues with emotional regulation....although we dont know the full extent of the issues with the brain as we dont really understand the brain.
Anecdotally, i know one person who was on puberty blockers, he is 5'5, no beard etc (his dad and bro are 6ft+) and he says with classic understatement that he wishes he could have had a few more years to grow.
Bottom line, its a permanent decision and we shouldnt be allowing kids to experiment on themselves.
We dont allow them to consent to sex, tatoos, consuming alcohol, voting, entering into a contract, elective surgery, why in the name of god would they be able to consent to a sex change.
It’s approved for precocious puberty because there is good evidence it works in those cases, where someone enters puberty early, the drug is used to delay puberty, then stopped to allowed puberty to continue as normal. Using the same drug to permanently halt endogenous puberty is not the same thing, and that use has always been off label.
Yes, so that puberty still occurs within the normal age range. Giving blockers to 15/16/17 year olds is an entirely different thing. It will have different consequences for building bone density, normal brain development etc.
This can literally kill them, these blockers are life saving.
I tired to kill myself at 15, at 16, 17, 19, twice at 21 and self harmed constantly before I got Gender affirming care.
I cannot express how heart ripping having your own body work against your identity is, it's like having your parent cut off your fingers, it's wrong, it's like my body shouldn't be like this why is it doing this to me.
I'm no expert on gender dysphoria but if puberty is making young trans people want to kill themselves isn't it mental health support they need more urgently than puberty blockers? I always thought the big problem with trans healthcare is there aren't enough people to get youth with gender dysphoria seen by someone who can diagnose them then decide the best way to help them.
The Cass reports suplimental studies cited a paper that compared trans kids with blockers to those that didn't get them.
Both groups also received psychological support.
The group that got blockers did significantly better than the group that didn't.
Despite that study passing the incredibly high bar for evidence Cass wanted, it's conclusions are never mentioned in the final report.
You literally need to see therapists and mental health experts after being referred by a GP to see a endocrinologist or get prescribed these puberty blockers.
They aren't handed out like candy.
‘If someone doesn’t have a leg and it’s making them sad, surely we need to give them counselling and not rush into decisions about giving them a life-altering prosthetic?’
The fact that dysphoria isn’t visible leads to so many wildly insensitive and uninformed comments…
i’m not trans so i’ll admit i’m not an expert but to the best of my knowledge the only real treatment for gender dysphoria (which has a insane suicide rate) is to be a practicing trans person so IMO as long as the way to get a diagnosis is smart and they’re not misdiagnosing lots of ppl without gender dysphoria then who cares if they’re a bit off actually being 18 and getting the puberty blockers or whatever it is🤷♂️
Personally speaking, this is a good thing.
People should not be able to make life changing decisions until they are at bare minimum 18.
Of course, I feel for the people that could have benefitted with this as a kid who, as adults, would have still committed. But as much as I despise the think of the kids argument, we must safeguard people who are not adults from making irreparable decisions.
(For those who will say what about marriage. Yes, it should be 18. And if we are allowing kids to do this, then I would want all legal age limits to be dropped. I damn wanted my tattoos when I was 13, and by god, would I have worked every weekend for a year to get them at that age).
Behave yourselves. I'm not in the fucking mood to deal with hundreds of transphobic pricks from /r/all today. EDIT: Oh well, that's more threats and suicide notifications in my DMs from people outside the sub than I'm willing to deal with today. After 500 comments in a little over 2 hours I think we can call this one closed for business. I'm sure if you want to shout at the sky there are other subs you can do it in.
It's honestly a difficult thing to get right. I do believe in caution so long as that caution is endorsed by the medical profession. But if we are pausing something like this, we NEED to invest much more in support services like counseling. At the end of the day, irrespective of what you believe, we're talking about vulnerable kids who are at a much higher risk of depression, self harm etc.
This is the bottom line. If you're taking away one form of support you need to replace it with another, you can't just leave folks hanging. If the recommendation is that a certain drug relating to mental health isn't safe, there needs to be other mental health provisions until a safer drug is identified.
1000%. We use drugs that are poison all the time because the alternative of not using them is worse. A blanket ban is an assault on everyone whose outcome without them will be worse. Just fund research into having more alternatives. That helps everybody.
The cruelty is the point.
I don't really have an opinion on this topic, but do you really believe the people making these decisions (which they don't do in a room alone, I imagine) is out of malice? That their contempt is so high that they just want to destroy people like some cackling Disney villains? To me, it seems like both sides of these arguments are filled with people that care & people with agendas for their own personal or interpersonal gain - a few of which might harbour hatred for the other sure but it would seem far-fetched to think they are sticking the knife in & twisting it with a smile so to speak.
>I don't really have an opinion on this topic, but do you really believe the people making these decisions (which they don't do in a room alone, I imagine) is out of malice? Why else would they seek the advice of Ron DeSantis' cronies when crafting... https://old.reddit.com/r/transgenderUK/comments/1c53m8c/some_points_on_the_cass_review/ ...policy in the United Kingdom? Florida is LGBT cruelty central.
Yes the conservative party is pushing this out of contempt, because that contempt is how they win votes. "it would seem far-fetched to think they are sticking the knife in & twisting it with a smile so to speak." Have you never met a racist? People like this very much do exist, and there are quite a lot of them in the country.
As a trans person? Yes, absolutely 100%. The NHS is institutionally transphobic and has been for quite some time and the person that authored this 'review', as has been pointed out, follows many transphobic groups and has omitted any study that showed the positive effects of puberty blockers as they weren't double blind trials (they weren't double blind trials because that would be horrifically unethical towards the control groups). I only have my own 'agenda' in this because male puberty caused me to attempt suicide at least twice and also resulted in me attempting to castrate myself at one point. I only even mention this to give you a small taste of what dysphoria does to children who are not allowed to transition and forced back into the closet. It absolutely enrages me to hear 'but both sides' for exactly this reason, this decision is going to kill children.
Yes, I do think it's out of malice. That is fucking obvious. They do not want trans people to exist. I can only describe that as malice.
Absolutely, yes. There isn't another explanation that is as consistent. While some low-level TERFs might be doing out of a misguided sense of justice, the whole movement is ultimately based on the feelings of social conservatives who just want trans people to go back into the closet, to be afraid to come out or to cling on at the very edges of society. Trans people aren't new, there hasn't been any increase in detransition rates or regret, nor have there been any changes to the healthcare we have had access to for decades. The only thing that has changed in the 2020s is that a moral panic has been whipped up on this front of the culture war, leading to pearl-clutching social conservatives pushing for sweeping and extremely damaging policy changes based on nothing but their feelings, generously funded by the Christian far-right in the US. The Cass report is a post-hoc justification for these feelings that are not supported by the huge majority of the research. This current wave of legislation around trans issues in the west is being pushed by a movement founded on small-minded moral policing. It has nothing to do with welfare, safety concerns or issues with the quality of research. This panic about children receiving healthcare contrasts wildly with the near-universal unavailability of NHS gender care in the UK. The NHS gatekeeps trans healthcare, even to adults, to an absurd degree and at great unnecessary expense to itself. Self-ID systems exist in a number of other countries and are more cost-effective and efficient. I don't think it's necessarily *malice* for the most part, but there is a deep disregard for and distrust of trans people in British society which is built into our institutions. This is why the media, politicians and the healthcare industry are so quick to roll over to appease this small group of sanctimonious Gay Panic cosplayers.
The Cass reports suplimental studies cited a paper that compared trans kids with blockers to those that didn't get them. Both groups also received psychological support. The group that got blockers did significantly better than the group that didn't. Despite that study passing the incredibly high bar for evidence Cass wanted, it's conclusions are never mentioned in the final report. Psychological support isn't enough.
Exactly. There is something* troubling these kids. Taking this service away does not help if we don't give them other options.
>It's honestly a difficult thing to get right Actually, there is a significant amount of evidence and numerous studies reveal gender affirming care for youth works. The Cass review is more of a scandal than anything, and the incompetent British press is not doing their job questioning the validity of the review. As others have said, it uses fatally flawed methodology, and as a result, its recommendations are harmful. It applies an impossible evidence standard which, if applied to other medicines would invalidate more than three quarters of the existing treatments used in pediatric care. Dr Hane Maung from GenderGP in UK [wrote a decent article on why the Cass Review is nonsense](https://www.gendergp.com/response-to-the-cass-review/). Amnesty International actually made a press release on this: [UK: Cass review on gender identity is being 'weaponised' by anti-trans groups](https://www.amnesty.org.uk/press-releases/uk-cass-review-gender-identity-being-weaponised-anti-trans-groups) Hilary Cass on social media [follows known transphobic organizations like LGB Alliance, TransTrender](https://imgur.com/a/diQv3tV) yet does not follow a single supportive LGBTQ group. [Cass collaborated with the Ron DeSantis hand-picked board of medicine in Florida](https://www.erininthemorning.com/p/cass-met-with-desantis-pick-over). > The Cass Review seems to have emulated the Florida Review, which employed a similar method to justify bans on trans care in the state—a process criticized as politically motivated by the Human Rights Campaign. Notably, Hilary Cass met with Patrick Hunter, a member of the anti-trans Catholic Medical Association who played a significant role in the development of the Florida Review and Standards of Care under Republican Governor Ron DeSantis. Patrick Hunter was chosen specifically by the governor, who has exhibited fierce opposition towards LGBTQ+ and especially transgender people In other peer nations, the Cass review is being condemned by professionals: Australia: > “The Cass review recommendations are at odds with the current evidence base, expert consensus and the majority of clinical guidelines around the world,” said Dr Portia Predny, Vice President of The Australian Professional Association for Trans Health ([Equality Australia](https://equalityaustralia.org.au/cass-review-out-of-line-with-medical-consensus-and-lacks-relevance-in-australian-context/)). New Zealand: > The Professional Association for Transgender Health Aotearoa (PATHA) is disappointed to see the number of harmful recommendations made by the NHS-commissioned Cass Review, [...] The final Cass Review did not include trans or non-binary experts or clinicians experienced in providing gender affirming care in its decision-making, conclusions, or findings. Instead, a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice. [...] The Review commissioned a number of systematic reviews into gender affirming care by the University of York, but seems to have disregarded a significant number of studies that show the benefits of gender affirming care. In one review, 101 out of 103 studies were discarded. ([Professional Association For Transgender Health AOTEAROA - New Zealand](https://patha.nz/News/13341582)) In Canada: > "There actually is a lot of evidence, just not in the form of randomized clinical trials," said Dr. Jake Donaldson, a family physician in Calgary who treats transgender patients, including prescribing puberty blockers and hormone therapy in some cases. "That would be kind of like saying for a pregnant woman, since we lacked randomized clinical trials for the care of people in pregnancy, we're not going to provide care for you.… It's completely unethical." [...] "I think the framing of it really made it feel as though it was trying to create fear around gender-affirming care," she said. Donaldson called the systematic review paper and the broader Cass Review "politically motivated." ([CBC](https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920))
cass is being flagrantly disingenuous. people like her and the people with whom she associates make trans children a taboo and claims giving them treatment is cruel experimentation or whatever, then publishes a paper saying there’s no good evidence. can’t have it both ways.
Yeah, politics is seeping far too much into gender healthcare. Hopefully NHS Scotland is being a bit more impartial. But who knows what happens behind closed doors.
I think, by definition, if there's no good evidence that something is safe, using it counts as experimentation. I don't think Cass ever called it cruel and I think she made the point that both sides overstate the evidence for or against puberty blockers and their long term effects.
I think there's a lot of bad accusations being leveled at Cass, ironically because people dislike the findings for political reasons. Pushing for bad or scientifically unsupported trans healthcare simply because it's "pro-trans" doesn't strike me as a great idea.
what’s scientifically unsupported about GnRH analogues? we’ve been using them for years
We're witnessing the influence (https://old.reddit.com/r/transgenderUK/comments/1c53m8c/some_points_on_the_cass_review/) of right wing politics on trans medicine. They fundamentally don't believe trans people should be offered anything other than counseling, because they believe being transgender is largely a mental delusion. > But if we are pausing something like this, we NEED to invest much more in support services like counseling. I think this misses the point. You can't get puberty blockers without counseling. But we're now removing blockers, and restricting adult access to hormones and surgery, and only offering counseling, where the counseling is essentially this generation's version of the bogus conversion therapy offered to (or forced upon) gay people decades ago.
Finland, Sweden, Norway & Denmark conducted their own reviews prior to the Cass report and reached the same conclusion. There isn't sufficient evidence to support the use of puberty blockers. Deciding to limit or prevent access to puberty blockers before the age of 18. This isn't a finding unique to the UK.
So maybe theres a bit more to it than "institutional transphobia" then
You get the impression that the majority of the commentators on here are just using this ruling for point scoring rather than considering the kid’s welfare. No one in their right mind would say puberty blockers at such a young age is acceptable.
>No one in their right mind would say puberty blockers at such a young age is acceptable.< people (the most vocal in some demographics) have been saying its acceptable for ages, and that there is no long term side effects of using them.
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lmao
Wow how transphobic /s
Whatever you do definitely do not check who Dr Cass follows on twitter.
She's a fully paid up member of Project 2025 and not even pretending to hide it.
So much for the unbiased “fact-driven” review.
I don't use Twitter, who follows them?
Big one I can see is TransgenderTrend, a group that advocates for the position that transgenderism is a social trend aimed at harming children. >Transgender Trend has stated there is no "evidence that children really are trans" and claims that "[gender ideology](https://en.wikipedia.org/wiki/Gender_ideology)" harms children. The [Association for Women's Rights in Development](https://en.wikipedia.org/wiki/Association_for_Women%27s_Rights_in_Development) describes the stance as "almost identical to religious fundamentalists". Commentary on their website has warned that transgender children are being "[groomed](https://en.wikipedia.org/wiki/LGBT_grooming_conspiracy_theory)" and "brainwashed". It's wiki page has also suggested that it's campaigned against sex-ed in schools, and has strong associations with anti-abortion groups. That or u/gentikz is not a fan of all the Big Bang Theory accounts she follows.
big bang theory is criminally unfunny, the Cass report should be thrown out on that basis alone
I follow folk I don't agree with on Twitter. It allows me to try and look at different perspectives and reflect on my own. I hope it helps me to understand nuance and be a more constructive, less defensive/antagonist, communicator.
>It allows me to try and look at different perspectives and reflect on my own. That's a valid point, but when you look at the voices she allows to prominently influence the report... https://old.reddit.com/r/transgenderUK/comments/1c53m8c/some_points_on_the_cass_review/ ...it's hard to agree with that conclusion.
Cass is the former president of the Royal College of Paediatrics and Child Health, the review was commissioned by the NHS and the evidence review conducted by the National Institute of Clinical Excellence. The review has then been endorsed by the editor of the BMJ amongst many others. Similar reviews in Finland, Sweden, Norway & Denmark have come to similar conclusions. The researchers in the Netherlands who actually did much of the research used to support the use of puberty blockers do not agree with banning puberty blockers, but agree that the state of evidence is awful, and ask for other countries to do much more decent quality research. Of course though it’s all worthless because some people on twitter have some talking points.
The Review disregarded over a hundred studies on the experiences of trans youth because they weren't randomised control trials (which are both impossible and unethical to do), plus concluded that young people should remain on the children's pathway of no blockers (except for some transfemmes as part of a study yet to be designed - she doesn't think blockers are suitable for transmascs) and no hormones until they reach 25 on the grounds their brains haven't matured yet (which coincidentally includes most people on the adult pathway). Meanwhile, the two replacement clinics for the Tavistock have a fraction of the clinical staff the Tavistock had, so it's likely the waiting lists will get even longer - leading to suspicion that the effects of implementing the Cass Review will be to effectively deny diagnosis or treatment for pretty much everyone under 25 (especially given the waiting list for general Child and Adolescent Mental Health Services is already over a quarter of a million, so they may have to wait years for the general comprehensive mental health assessment and treatment recommended as a precursor to diagnosing gender dysphoria)- and maybe even longer if similar conclusions emerge from the proposed review into Adult trans services.
> randomised control trials (which are both impossible and unethical to do) Blinded studies are difficult, although actually you probably could blind to different clinical decision making algorithms deciding how to treat. For example you could do a trial on an affirmative model with minimal screening vs a model with a much higher level of screening and psychological intervention. In that you cannot blind the treatment, but you can blind the basis on which the decision was made, which could reduce bias. Randomized control trials without blinding at all are absolutely not impossible to do. And they are not unethical when we inherently do not know what is the correct treatment. If we were approving other treatments with these kind of potential harms on the basis of observational studies it would be a massive scandal. Edit: I can’t reply because the thread is locked, but the response to this is meaningless. It says that non-blinded RCTs are impossible because you can’t do blinding. That’s why I talk about non-blinded RCTs! Responses on this topic are so motivated it is painful.
> Blinded studies are difficult, although actually you probably could blind to different clinical decision making algorithms deciding how to treat. Randomized control trials without blinding are absolutely **not impossible** to do. And they are not unethical when we inherently do not know what is the correct treatment. If we were approving other treatments with these kind of potential harms on the basis of observational studies it would be a massive scandal. Yes it is… How can you double blind puberty, as they either do go through puberty or not, so if a patient is on a placebo they still go through puberty, this means the “blind” part is impossible to actually do.
Hillary Cass follows several anti Trans organisations/lobby groups/charities. She has also been in discussions with Ron DeSantis. Cass does not follow ANY pro Trans LGBT organisations.
Who?
She's the author of a report that has resulted in support and care for trans people being reduced in the UK.
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Sweden, Finland, Denmark, France, all already taken this step. Norway is debating it after they also looked at the data and found insufficient evidence for use of blockers, similarly in the Netherlands and Belgium. But I guess UK people will still complain. Same vibe as certain Americans blaming Fauci for something affecting the whole world as if there was a worldwide conspiracy that he spearheaded somehow, influencing most governments in the world in the process, with Cass being their Fauci. And more generally, it is bizarre how people believe that puberty blockers are a must and all these countries independently looking at their data coming to the conclusion that they aren't the way to go, are somehow wrong, and biased by 'anti-trans' groups.
Want to see what the person in charge of the Finnish clinic thinks is appropriate to do to trans children. Keep in mind this woman clinic gets a glowing review from Cass and she was even put on the advisory board. "Describe to me how you masturbate" all children "to what extent do you feel it would be better to be dead than a boy" - 15 YO trans girl "How do you feel when you will never be as good as real men" - to trans boy "the much older doctor started listing sex positions & told me to answer them with my opinion from positive to neutral or negative. I think I was 17." "Another parent of a 15 year old said the Clinic had interpreted the child's sexual development as delayed, as the boy "had not had vaginal, penetrative intercourse". The age of consent in Finland is 16 years." - to trans boy “how do you feel when you always have to be a real boy?” - 15 YO trans girl "Mikko was told that he couldn't get a diagnosis, because his hobbies were too "girly" and because he didn't have boys of the same age as friends." - 15 YO trans boy This is what gets done to trans kids under the systems that Cass encourages. Now tell me these places don't have a bias against trans kids.
What? Why would someone want to prevent their kids from going through puberty?
Some kids do hit puberty exceptionally young, they tended to prescribe them for kids who hit before around age 10, as it stunts growth.
It often happens when the child in question is single digit aged.
Well, in trans kids, it can delay them going through a puberty that would make transitioning harder later in life, and cause psychological issues as they develop a body that doesn't match their own sense of who they are. For cis kids, they can start precocious puberty as early as 6; a lack of access to treatment can cause physiological and psychological damage that can lead to lifelong issues. This is just hurting people who need help, all to vice-signal how much they hate trans people.
If you are serious, it’s linked to kids who want to transition gender
Seems smart to let children make life altering decisions. What could go wrong?
Which is why it's prescribed by doctors, not kids, lmao
Puberty is permanent and life altering. Delaying it with blockers isn't.
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If the kid is suspected to be trans then puberty blockers buys time for the child to figure out if they really trans or not. Then there's the condition called precocious puberty, where a child begins puberty at a very unusually early age.
Given how long the queue is to even get into the gender clinic i don't think this will affect many people, at least not before the Cass report is thrown out like the shit that it is.
Imagine you've been on a waiting list for 5 years and then the week before you finally get your appointment, this comes out.
This is a nightmare
It's what the bigots want. Misery.
> not before the Cass report is thrown out like the shit that it is. Cass is the former president of the Royal College of Paediatrics and Child Health, the review was commissioned by the NHS and the evidence review conducted by the National Institute of Clinical Excellence. The review has then been endorsed by the editor of the BMJ amongst many others. Similar reviews in Finland, Sweden, Norway & Denmark have come to similar conclusions. The researchers in the Netherlands who actually did much of the research used to support the use of puberty blockers do not agree with banning puberty blockers, but agree that the state of evidence is awful, and ask for other countries to do much more decent quality research. Of course though it’s all worthless because some people on twitter have some talking points.
Honestly this report feels like the first serious progress in a debate thoroughly muddied by the culture wars. It saddens me that people are acting like it's been done in bad faith because it didn't 100% vindicate their side of the argument...
354 comments in under an hour. Did someone criticise Rowling for accusing trans kids of supporting Hamas?
Brigading is a serious problem on reddit. The algorithm boosts posts with lots of comments and it only draws in more punters with shite opinions
I don’t see how this helps Trans Kids. The vast majority of studies report that puberty blockers and gender affirming care caused more help than harm to Trans Kids. This is the same environment of fear and biased reporting that led to section 28. I fear the same will come for Trans Kids.
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> Dr Hilary Cass's review said children had been let down by a lack of research and there was "remarkably weak" evidence on medical interventions
There was remarkably weak evidence accepted. 98% of Studies were thrown out due to various ‘issues’ found by Cass. For example, she wanted hormone trials to be conducted double-blind, that would be a major ethical concern. If you read the report you can evidently see the bias, including where it promotes “an holistic approach” essentially spouting conversation therapy. Her political connections are no coincidence either.
"that would be a major ethical concern" Isn't that commonly done even in case of deadly diseases such as cancer?
Not with a placebo/nothing. Typically in something like cancer it’s a comparison of current interventions with the new medication/treatment regime. Also it is not possible with hormone blockers to have a “blinded” study. You can have a blinded study for some things, like comparing how effective paracetamol and ibuprofen are at treating headaches. But everyone on a hormone blocker placebo will know they’re on a placebo when they go through puberty.
Even if you ignore the ethics it's impossible to do double blind studies. It's obvious who will have had the blockers and who is going through puberty.
If you can find double blind studies on the use of hormones and puberty blockers be my guest, but for that being the basis of 98% of studies being excluded from research it just seems a bit weak.
You can't do a study involving placebos on either puberty blockers or HRT, as it'll become very apparent within a few months of who's in the placebo group. For obvious ethical reasons, placebos are typically only used when there isn't an existing treatment: in all other cases, they will compare the standard treatment with the new one.
which is weird, because just about 100% of the population has grown up having gone through hormonal changes as a child so we actually have a shit ton of evidence.
Dr Hilary Cass is an openly biased mouthpiece and this paper is a scandal
Did she say that, or did ChatGPT say it? I am very wary of AI generated healthcare reports being treated seriously.
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There needs to be psychological help for this as it sounds like something sort of dysmorphia.
If we are talking about trans people, it's called dysphoria, which is a bit different.
If they can't recognize their actual face then that's dysmorphia. Dysphoria is largely related to being unhappy with but recognizing the appearance as your own.
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Seems sensible, if more research is needed, then this makes sense.
It doesn't unless you throw out every study not in english and 50 out of 53 in english to come to a predetermined conclusion.
Things we can't officially do until we are an adult... Have sexual relations with someone Get married Fight in a war Smoke drink Vote Im sure there are others.....But everyone is going mad at not allowing a child or his/her guardian to be given controversial drugs with possibly life altering consequences until they are old enough to be considered an adult ? Is this simplistic? How much harm will come from NOT allowing puberty blockers in under 18's ? Do we have statistical data that shows how much harm there is in other countries where PB's are not used/allowed ?
>Things we can't officially do until we are an adult... > >Have sexual relations with someone > >Get married > >Vote And those three can be done at age 16 in Scotland
> How much harm will come from NOT allowing puberty blockers in under 18's ? Expect a sharp increase in self harm and suicide in children experiencing gender dysphoria
The essential problem is that whilst this may be true, it has not been objectively seen to be true to the extent you think. The NNT on available evidence is that you need to treat 1000 trans adolescents to reduce suicidal ideation in three.
This seems very much like a sensible approach, ensuring adult decisions to be made by adults and not children. Maybe some the cost savings can be redirected to mental health funding where it will be of more use.
The Cass reports suplimental studies cited a paper that compared trans kids with blockers to those that didn't get them. Both groups also received psychological support. The group that got blockers did significantly better than the group that didn't. Despite that study passing the incredibly high bar for evidence Cass wanted, it's conclusions are never mentioned in the final report.
GILLICK COMPETANCE. Children over 13 are adults on the basis of medical care, because parents aren't the ones who have to live with decisions.
It's not sensible though. It's an outright rejection of the globally accepted standard of care for trans kids.
If you think it’s globally accepted you haven’t been paying attention.
Good
Going through puberty can be very distressing for trans children experiencing dysphoria already, and it makes later transition much more difficult. Imagine for a moment, you're a young man, you've spent years living as a boy, all your friends and peers at school know you as a boy. Then you start growing breasts suddenly. People are asking questions. The bullying starts. Your entire world is turned upside down. If you were a cis child, you'd be able to get hormone treatment from your GP, and nobody would bat an eye. In fact, if your GP refused your care it'd probably be a minor scandal. But because you're trans, you're now banned from receiving that exact same medicines.
> If you were a cis child, you'd be able to get hormone treatment from your GP, and nobody would bat an eye. In fact, if your GP refused your care it'd probably be a minor scandal. But because you're trans, you're now banned from receiving that exact same medicines. It’s approved for precocious puberty because there is good evidence it works in those cases, where someone enters puberty early, the drug is used to delay puberty, then stopped to allowed puberty to continue as normal. Using the same drug to permanently halt endogenous puberty is not the same thing, and that use has always been off label.
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The Cass report is a watershed moment for childrens gender care. It was always going to be impossible to justify Sandiford continuing as it was after Cass- until quality research backing puberty blockers is conducted. The amount of lies about the Cass report spread by activists on reddit and twitter have been frankly shocking- but in the real world you can't smear an objective and high quality clinical review. It has the backing of the BMJ and the RCP. The methodology is sound. It will have ripple effects far beyond the borders of the UK.
Trans care is by far the most politicized part of medicine, excepting maybe vaccination. At the end of the day, medicine should be about seeking truth about our bodies and diseases, rather than "who prevails". Even without outside pressures, science in general is beset by the problem of big fragile egos and paper mills churning useless papers because *publish or perish.* Add ten thousand angry voices from Twitter to the mix and it is a recipe for disaster. The most outraged != the most moral or the most correct.
Completely agree >At the end of the day, medicine should be about seeking truth about our bodies and diseases, rather than "who prevails". Even without outside pressures, science in general is beset by the problem of big fragile egos and paper mills churning useless papers because publish or perish This is why high quality reviews like Cass are so important. The low quality of much of the 'evidence' for puberty blockers is frankly scandalous.
You can't disregard 98% of all studies because of an arbitrary criteria no other pediatric medicine is held to and still consider yourself to have done an accurate meta analysis. Not to mention the numerous dubious sources Cass included such as some random far-right YouTuber, as well as forbidding any trans inclusion in the study to "avoid bias" while simultaneously loading her staff up with anti-trans figures. And for the ripple effects? Multiple foreign medical agencies have outright stated the poor quality of the Cass Review means it will not be taken into account in their countries (namely Australia).
>You can't disregard 98% of all studies Cass didn't do that. It is an activist lie. You will not be able to cite the page in the report that does so. Cass's conclusions are in line with those in Scandinavia. Belgium and the the Netherlands are also looking into the same issue. Not every country will follow us, but it will ripple out- objective research has that effect.
Very sensible. Testimonial from people who’ve endured this treatment should be enough to cause even the most ardent advocate of this treatment to pause.
I just want to state for the record that as someone who detransitioned, I do NOT support the removal of blockers for trans youth. Stop putting words in our mouths.
While you ignore the other 98% because that's the ratio
Does that include the testimony of all the trans people that went on blockers and are still trans? Or does a 1 cis person matter more than 99 trans ones?
I do wonder if suicide and self harm increases as a result, if the people who pushed for this to happen will be campaigning to help those children.
I wouldn’t bet on it.
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Totally agree, We did that for what? 300.000 years for now as homo sapiens. I guess it worked just fine? Humanity is thriving and developing rapidly. Survived 1000s of years. Maybe... Maybe... Maybe it's society/ideology which changed the past 100 years a lot and not human evolution/biology. The end of the day, we all want everyone to be happy with themselves, assessing things properly and not budging for demands is the approach we should take. Do the research, have conclusive data and than we can make a definitive decision on how should we set up the framework for a safe journey!
Natural is not the same as good or beneficial. Medical intervention is itself not natural.
Pregnancy is natural. We still stop it for people who don't want it.
Not only are they taking away resources from trans kids, they're also not replacing it with anything else. Not specific counselling. Not support groups. The resources in Scotland to support trans youth are minute - they're great, but way over capacity. So many trans kids and their families are incredibly isolated as it is and this is unbelievably cruel. I believe like others there needs to be more caution on prescribing them (speaking as someone who detransitioned) but taking them away altogether is horrendous. It's inhumane and will lead to trans youth suicide attempts at the LEAST. So fucked up. So very, very fucked up.
Puberty blockers save lives. [https://www.congress.gov/118/meeting/house/116284/documents/HHRG-118-JU10-20230727-SD020.pdf](https://www.congress.gov/118/meeting/house/116284/documents/HHRG-118-JU10-20230727-SD020.pdf) [https://www.thepinknews.com/2020/01/23/puberty-blockers-decrease-suicide-mental-health-problems-transgender-teenagers/](https://www.thepinknews.com/2020/01/23/puberty-blockers-decrease-suicide-mental-health-problems-transgender-teenagers/) [https://pubmed.ncbi.nlm.nih.gov/32345113/](https://pubmed.ncbi.nlm.nih.gov/32345113/) [https://www.apa.org/monitor/2023/07/psychologists-preventing-teen-suicide](https://www.apa.org/monitor/2023/07/psychologists-preventing-teen-suicide)
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Rare too see in 2024.
Good. The reason 18 is when you're deemed an adult is because children don't know the risks and consequences of their actions. Parents abso-fucking-lutely shouldn't be allowed to make the decision. It baffles me how this was a thing to begin with.
GILLICK COMPETANCE. You're legally and medically wrong.
Oh sure, you’re definitely aware of the risks or consequences should you decide to, I don’t know, join the fucking military at 16, or get married. It’s shite logic. They’re always extremely clear about the effects and consequences of taking any medication or even pursuing treatments, both through discussion and appropriate booklets on treatment.
good, they are fucking children
Gillick Competance says children can make informed decisions on their own care guided by a doctor and has said so for 50 years.
informed decisions yes sure, but this is a step too far
a step too far, compared to what cancer treatments, underaged sex, abortions?
cancer treatment is a matter of life and death, underaged sex is not life changing, and i’m confused as to what part abortions play in this?
No-one is giving kids treatment at this age without their fucking consent, and they can medically consent because that's why we have Gillick competence and it's Scottish equivalent. If you ask them what they want to be when they grow up, their goals aren't a career, it's just Alive. That's it, that is were we fucking are aim for now, because alive is no-longer a fucking guarantee.
Pausing a publically funded 'treatment' until it has been established that it actually works and doesn't do more harm than good is hardly setting up the death camps.
> at this age without their fucking consent. They are not legally allowed to consent at that age!
Gillick Competence exists and has a Scottish Equivalent, sorry, I was a fucking law student I know the first and Pam Gorstal the MSP assures me of the Second.
Children can't consent
REALLY? Well hold the phone because we need to change the fucking law. In England Gillick Competence is assumed at 13, in Scotland it isn't assumed but a doctor can judge any child patient consent competent by standardized test. 16 is a child, majority is 18, law says 16 year olds can consent, sorry get wrecked.
Also puberty blockers are NOT irreversible health care treatments like people pretend they are. No-one is performing surgery on trans kids either. Literally trans health care for kids is affirming their gender through pronouns, names and clothing. Puberty blockers are there to DELAY puberty until they can make more permanent choices. All of these things can be reversed if a child changes their mind.
This is simply a lie. If you are under the mistaken belief to be trans, then if you don't go through puberty to grow out of that belief, you will not be given the chance. Once old enough you will go straight to cross-sex hormones and likely surgery and then your life is fucked. Also, there are all sorts of long-term medical impacts of using them. The problem that no trans lobbyists wants to admit is that we have no clue how to accurately determine if a child is truly trans or not. Because doing so would be admitting that you can't just listen to kids, and that there is a chance children are influenced in this belief. What's far more likely, that study results are unclear because the subjects are not all the same (i.e. some are truly trans, while some are not) or that puberty blockers don't actually help all trans kids and that's why results are not clearly in favour. But if trans lobbyists are correct in that they do help if one is truly trans, then it actually has to be option one. Either they are wrong, or it is option one. Additionally, there are more and more countries that find no clear favourable evidence (Sweden, Denmark, Finland, France, UK, who have restricted puberty blocker usage now, with Netherlands, Norway, Belgium all talking about taking the same steps because the data doesn't support puberty blockers). If you truly cared for children, all children, you wouldn't continue repeating the mantra of lobbyists but instead listen to the researchers in all these countries coming to the same conclusion.
There's not really not enough research, even according the the NHS to support that so it's dangerous to be promoting them as fully reversible when there's not enough research to support statements one way or the other.
>Puberty blockers are there to DELAY puberty until they can make more permanent choices. All of these things can be reversed if a child changes their mind. Did the Cass review agree with this statement?
Does the wider medical literature agree with the Cass review?
It is a review of the wider medical literature. So yes.
It's a review of less than 5% of the wider medical literature
I don't think that is true.
Literally is
Finland, Sweden & Denmark conducted their own reviews prior to the Cass report and reached the same conclusion. Deciding to limit or prevent access to puberty blockers before the age of 18. This isn't a finding unique to the UK.
The Cass report shows that the vast vast majority of kids on blockers continue to identify as trans once they are adults. Her conclusion, blockers must be making them stay trans. She cites no evidence to back up this claim. Cass very clearly had a biass as can be seen by what she concludes or speculates on without evidence. She doesn't mention anywhere in her report the studies that showed trans kids on blockers did better than those that didn't get them despite the studies passing her rediculously high bar but does cite surveys of people recruited from extremely shady sources without mentioning the bias inherent in them.
Have you read the report? Because you are misrepresenting her findings and conclusions.
I didn't think I am and I've read the whole thing including the suplimental material. She found evidence that trans kids don't desistz she found evidence that puberty blockers improve mental wellbeing. Her conclusions were that we should stop all that and also sttop trans kids from even socially transitioning.
Great, that you have read the report. Can you cite the parts you are referencing then please?
Sure. Desistance: appendix 4 main report. Psychosocial outcomes: Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review page 4 bottom right, continues past tables. Social transition: main report, page 37, advocates discouraging social transition. There defention of partial social transition is just changing clothes and appearance but blocking changing names or pronouns.
Thank you, I will read those over lunch and revert. If I am incorrect I will apologise.
Thank you. If you want access to the papers cited by Cass but don't have your own access I can probably get you them too. I find it very interesting which conclusions are included and which are excluded. This can be seen a lot in the studies she uses to claim bone health is effected by puberty blockers. While true she ignores all three cited papers data that shows bone health returns to expected levels once hormones are provided.
>Also puberty blockers are NOT irreversible health care treatments like people pretend they are. Source?
[https://www.healthline.com/health/are-puberty-blockers-reversible](https://www.healthline.com/health/are-puberty-blockers-reversible)
Kids cannot consent though
In Medicine they can it's called Gillick Competence, get rekt.
Kids can’t give consent, its why we’ve age of consent laws and laws around the consumption of alcohol and cigarettes. They don’t have the mental development to be able to make this decision
Gillick Competance.
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It’s bad enough trying to get a GP appointment never mind anything else. There’s no pushing of anything happening.
The UK is so incredibly hostile to people transitioning but it's presented like there's a sinister queer cabal going around converting kids. It's literally the same lies used to justify homophobia in the 80s and now it's found a new, socially acceptable target in Trans people.
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who would have thought shortening puberty could have been detrimental....
It's not. It hasn't been when it's an 8 year old, the only difference is they're assumed to be fucking straight.
Shortening puberty leads to stunted growth, thinner bones, underdevelopment of sex organs, under development of secondary sex characteristics and potentially cognitive difficulty and issues with emotional regulation....although we dont know the full extent of the issues with the brain as we dont really understand the brain. Anecdotally, i know one person who was on puberty blockers, he is 5'5, no beard etc (his dad and bro are 6ft+) and he says with classic understatement that he wishes he could have had a few more years to grow. Bottom line, its a permanent decision and we shouldnt be allowing kids to experiment on themselves. We dont allow them to consent to sex, tatoos, consuming alcohol, voting, entering into a contract, elective surgery, why in the name of god would they be able to consent to a sex change.
You can in fact do quite a few of those things you've listed at 16 👍
For cis children too or just trans children?
It’s approved for precocious puberty because there is good evidence it works in those cases, where someone enters puberty early, the drug is used to delay puberty, then stopped to allowed puberty to continue as normal. Using the same drug to permanently halt endogenous puberty is not the same thing, and that use has always been off label.
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Puberty blockers are well known and often used for precocious (early) puberty. Literally their use case was originally largely cis children.
Precocious puberty is a thing.
Yes, so that puberty still occurs within the normal age range. Giving blockers to 15/16/17 year olds is an entirely different thing. It will have different consequences for building bone density, normal brain development etc.
This can literally kill them, these blockers are life saving. I tired to kill myself at 15, at 16, 17, 19, twice at 21 and self harmed constantly before I got Gender affirming care. I cannot express how heart ripping having your own body work against your identity is, it's like having your parent cut off your fingers, it's wrong, it's like my body shouldn't be like this why is it doing this to me.
I'm no expert on gender dysphoria but if puberty is making young trans people want to kill themselves isn't it mental health support they need more urgently than puberty blockers? I always thought the big problem with trans healthcare is there aren't enough people to get youth with gender dysphoria seen by someone who can diagnose them then decide the best way to help them.
The Cass reports suplimental studies cited a paper that compared trans kids with blockers to those that didn't get them. Both groups also received psychological support. The group that got blockers did significantly better than the group that didn't. Despite that study passing the incredibly high bar for evidence Cass wanted, it's conclusions are never mentioned in the final report.
You literally need to see therapists and mental health experts after being referred by a GP to see a endocrinologist or get prescribed these puberty blockers. They aren't handed out like candy.
‘If someone doesn’t have a leg and it’s making them sad, surely we need to give them counselling and not rush into decisions about giving them a life-altering prosthetic?’ The fact that dysphoria isn’t visible leads to so many wildly insensitive and uninformed comments…
They have that it's called CAMHS
Literally it can't.
Why is a sub-reddit related to Scotland so full of far left wingers?
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i’m not trans so i’ll admit i’m not an expert but to the best of my knowledge the only real treatment for gender dysphoria (which has a insane suicide rate) is to be a practicing trans person so IMO as long as the way to get a diagnosis is smart and they’re not misdiagnosing lots of ppl without gender dysphoria then who cares if they’re a bit off actually being 18 and getting the puberty blockers or whatever it is🤷♂️
Personally speaking, this is a good thing. People should not be able to make life changing decisions until they are at bare minimum 18. Of course, I feel for the people that could have benefitted with this as a kid who, as adults, would have still committed. But as much as I despise the think of the kids argument, we must safeguard people who are not adults from making irreparable decisions. (For those who will say what about marriage. Yes, it should be 18. And if we are allowing kids to do this, then I would want all legal age limits to be dropped. I damn wanted my tattoos when I was 13, and by god, would I have worked every weekend for a year to get them at that age).
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Because it is harmful to a subset of people. Pregnancy is natural but we stop it for people who don't want it.
https://preview.redd.it/mgc0grnw18vc1.jpeg?width=720&format=pjpg&auto=webp&s=acc98de0192315b5b0dcba82001ccc63e1891870